IMPORTANT PATIENT UPDATES
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In May 2021, the CDC updated its social distancing guidance for people fully vaccinated against COVID-19. Per the CDC, fully vaccinated people can now resume activities without wearing a mask or physically distancing, except in certain settings, which include while traveling and in healthcare settings.
The safety of our patients and staff is very important to us. Therefore, masks are still required for all patients, visitors and staff at Rheumatology Associates. Thank you for helping us keep our patients and staff safe and healthy.
The CDC also noted that people who are taking medications that weaken the immune system may still be at risk for COVID 19 infection even when vaccinated and should talk to their healthcare provider to discuss their activities.
Many of our patients have asked, “What can I safely do without wearing a mask?”
There have been a small number of studies published to try to address this question, and more studies are ongoing. So far, it appears that the majority of rheumatology patients have a detectable antibody response to the vaccine. However, the antibody levels achieved by patients on immune suppressing medications appears to be lower on average, compared with people not on those medications. At this time, we do not know what that means for risk of infection for these patients, if they are exposed to COVID-19.
Some medications appear to have a stronger impact on the immune system’s response to the vaccine. Patients on the following medications appear to be most impacted, and likely have a lower degree of protection following vaccination:
Rituxan (Truxima, Ruxience, Riabni)
The following medications also have been shown to decrease the immune response to the COVID-19 vaccines:
JAK inhibitors (Xeljanz, Olumiant, and Rinvoq)
TNF inhibitors (Enbrel (Erelzi, Eticovo); Humira (Amjevita, Cyltezo, Hyrimoz, Hadlima, Hulio); Simponi; Simponi Aria; Remicade (Inflectra, Renflexis, Ixifi, Avsola); Cimzia)
Mycophenolate (CellCept, Myfortic)
In addition, it is likely that patients on Orencia and Cytoxan (cyclophosphamide) will not have a full immune response to the COVID-19 vaccine.
We do not at this time know what level of antibodies following vaccination are necessary for protection from infection. It is possible that lower antibody levels are still enough to protect patients well from COVID-19 infection, but we do not know for sure.
For that reason, we advise all fully vaccinated patients on any form of immune suppressing medication to continue to be cautious with social activities, particularly activities involving larger crowds, where the vaccination status of other people may not be known. It is likely safe to gather in small groups with fully vaccinated people that you know well, and whose vaccination status is known to you. It is also likely safe to gather outdoors with people, including likely larger gatherings. However, in more public settings and particularly indoors, we recommend continuing to follow social distancing principles, including wearing a mask, staying six feet or more away from others as much as possible, and washing hands regularly.
COVID-19 Vaccine Information (updated 5/24/2021)
As of May 24, 2021, there are three available vaccines against the coronavirus that causes Covid-19 in the US. These were developed by Pfizer, Moderna and Johnson and Johnson. All three vaccines have been approved by the FDA for emergency use based on their efficacy and safety.
The Pfizer and Moderna vaccines require two doses, while the Johnson and Johnson vaccine requires only one dose. In general, vaccination is expected to far outweigh any risk from the vaccine. At Rheumatology Associates, we believe that getting vaccinated is very important and we are urging all of our patients to get any of the available vaccines.
Should I adjust my medications around the time of vaccination?
When getting ready to receive your vaccine, please be aware that The American College of Rheumatology has recently published guidance regarding the use of immune suppressing medications around the time of the vaccine. Based on the available information, patients taking the following medications may continue them without change: Prednisone <20 mg/day (or glucocorticoid equivalent), sulfasalazine, leflunomide (Arava), mycophenolate (Cellcept, Myfortic), azathioprine (Imuran), oral cyclophosphamide, Enbrel (erelzi, eticovo), Humira (amjevita, cyltezo, hyrimoz, hadlima, hulio), Simponi, Simponi Aria, Remicade, Inflectra, Renflexis, Ixifi, Avsola, Cimzia, Actemra, Kevzara, Cosentyx, Taltz, Tremfya, Stelara, Kineret, Ilaris, Benlysta, Cyclosporine, and Tacrolimus.
Patients receiving other medications such as Methotrexate, Xeljanz, Olumiant, Rinvoq, Orencia (both self-injections and intravenous), Rituximab (truxima, ruxience, riabni) and intravenous Cyclophosphamide may benefit from temporarily holding the medication when receiving the vaccine if their disease is well controlled and may allow it. Before holding or making any changes to your medications, please contact your provider.
Additional recommendations include holding Acetaminophen and NSAID’s (over the counter or prescription) for 24 hours prior to vaccination. There are no recommended restrictions on use post vaccination to treat symptoms.
Who can get vaccinated right now in Texas?
The state of Texas is now offering vaccines to everyone 12 years old or older.
Where can I get a vaccine for Covid-19?
Rheumatology Associates is not offering vaccination services against COVID-19 at this time, but please check our website frequently for new updates. If you are trying to find where to get vaccinated please check COVID-19 Vaccine Information (texas.gov) or call 211 for a referral to a local vaccine provider.
What should I do if I am diagnosed with Covid-19?
If you have confirmed or strongly suspected COVID-19, please contact your PCP for instruction about where to go to be evaluated or get tested or go to urgent care or ER if your symptoms indicate you require immediate medical attention. Let your rheumatologist know about your diagnosis as he/she may have specific recommendations on what to do.
In general, if you are on immune suppressing medication (such as sulfasalazine, methotrexate, azathioprine, CellCept, Cytoxan, any injectable or infusion medication for autoimmune disease, Xeljanz, Olumiant, or Rinvoq), we recommend stopping the medication immediately. This will help your body be better able to fight off any infection. Once you are clearly improving and the infection is resolving, you can resume your immune suppressing medication.
If you are on Plaquenil (hydroxychloroquine), you may continue it.
We recommend using the CDC’s Coronavirus Self-Checker, it is an interactive clinical assessment tool that will assist individuals ages 13 and older, on deciding when to seek testing or medical care if they suspect they or someone they know has contracted COVID-19 or has come into close contact with someone who has COVID-19.
We also recommend visiting the CDC’s webpage about COVID-19 for the most up to date information about the virus. This can be found at: https://www.cdc.gov/coronavirus/2019-ncov/index.html